You may have heard about a new kind of health care directive in Vermont, called a Clinician Orders for Life-Sustaining Treatment (COLST) form. Here, we discuss what a COLST form is and when you might need one.
A COLST form is a doctor's order that helps you keep control over medical care at the end of life. Like a Do Not Resuscitate (DNR) order, the form tells emergency medical personnel and other health care providers whether or not to administer cardiopulmonary resuscitation (CPR) in the event of a medical emergency. Vermont's COLST form is intended to replace its former DNR form. In fact, it is often referred to as a DNR/COLST form. But the COLST form may also provide other information about your wishes for end-of-life health care, as explained just below.
A health care professional can help you create a COLST form if you enter a medical facility or health care setting -- such as a hospital, nursing home, or hospice care in a facility or at home. If a member of the medical staff does not ask you whether you want to create a COLST form, you may ask for one.
To be legally valid, a COLST form must be signed by:
A COLST form may be printed on brightly colored paper so it will easily stand out in your medical records. The form travels with you if you move from one health care setting to another. You can change it or cancel it at any time.
A COLST form differs from a DNR order in one important way: A COLST form also includes directions about life-sustaining measures in addition to CPR, such as intubation, antibiotic use, and feeding tubes. The COLST form helps medical providers understand your wishes at a glance, but it is not a substitute for a properly prepared advance directive.
An advance directive provides more information than a COLST form, including details about your health care agent, more complete health care wishes, and your preference for organ donation.
You need to consider a COLST only if you're facing a life-threatening medical condition. If you're healthy, you need only an advance directive to provide a full set of wishes for your treatment in the event of an unexpected accident or medical crisis.
On the other hand, a patient diagnosed with a terminal illness or frailty that requires care in a medical setting -- or ongoing care at home -- may need a COLST in addition to a traditional health care directive. That's because an advance directive may not be enough to prevent medical personnel from resuscitating a patient in an emergency. For that, it's important to have a medical order such as a DNR/COLST form. If you feel strongly that you don't want emergency measures at the end of life -- or if you're caring for someone who feels that way -- find out about making a COLST in addition to an advance health care directive.
For details about preparing health care directives in Vermont, see Vermont Living Wills and Advance Directives: What You Need to Know.
For general information about how to document your health care wishes, see the Living Wills & Medical Powers of Attorney section of Nolo.com.
For more on Vermont estate planning issues, see our section on Vermont Estate Planning.